The American journal of emergency medicine
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We report a case of a 78-year-old woman, previously in good health, who was endotracheally intubated and brought to the emergency department following sudden cardiac arrest. Physical examination revealed absent breath sounds over the right hemithorax, and a portable chest radiograph demonstrated left mainstem bronchus intubation. Although right mainstem bronchus intubation is a common complication of endotracheal intubation, left mainstem bronchus intubation is rare.
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In order to determine whether paramedics could be effectively trained in the skill of orotracheal intubation, 11 paramedics were entered into a pilot study. All paramedics received the same limited didactic, cadaver, and in vivo clinical preparation. ⋯ Subsequently, training has been expanded to a large number of paramedics, and the experience with intubation now includes a total of 128 patients and an overall success rate of 86%. It is concluded that paramedics can safely and effectively perform orotracheal intubation in a variety of adverse field conditions.
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Perfusion of the cerebral cortex (rCCBF) during resuscitation from cardiac arrest was studied using 24 large dogs and three different resuscitation models. Conventional cardiopulmonary resuscitation (CPR) was compared with interposed abdominal compression CPR (IAC-CPR) and with IAC-CPR together with infusion of epinephrine. ⋯ With epinephrine, IAC-CPR produced rCCBF (0.93 +/- 0.49 ml/min/g) statistically indistinguishable from normal. Both models of IAC-CPR were significantly superior to conventional CPR in perfusion of the cerebral cortex.
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A circulatory arrest model in the rat was developed for use in cerebral and cardiac resuscitation studies. Whole-body ischemia was produced for 8 to 18 minutes by arresting the heart with a cold potassium chloride cardioplegic solution. Following cardiopulmonary resuscitation, minimal, standardized intensive care was provided. ⋯ Thirty per cent of the rats recovering from 11 minutes of ischemia suffered motor seizures. Survival and the incidence of motor seizures appear to be good measures of outcome following ischemic circulatory arrest. These measures can be used to test the possible anti-ischemic actions of calcium antagonists or other drugs.
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To investigate alternative mechanisms generating artificial circulation during cardiopulmonary resuscitation (CPR), an electrical model of the circulation was developed. Heart and blood vessels were modeled as resistive-capacitive networks; pressures in the chest, abdomen, and vascular compartments as voltages; blood flow as electric current; blood inertia as inductance; and the cardiac and venous valves as diodes. External pressurization of thoracic and abdominal vessels, as would occur in CPR, was simulated by application of half-sinusoidal voltage pulses. ⋯ Flow was greatest with the CP, less with the TP, and least with the AP mechanism. However, the AP could be practically combined with either the CP or TP by interposition of abdominal compressions between chest compressions (IAC-CPR). Our model predicts that this combined method can substantially improve artificial circulation, especially when cardiac compression does not occur and chest compression invokes only the thoracic pump mechanism.